title: Relation of left ventricular infarct transmurality and infarct size after primary percutaneous coronary angioplasty to time from symptom onset to balloon inflation.
abstract: This study was performed to evaluate the impact of time to reperfusion on infarct size and transmurality after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). In 73 patients undergoing primary PCI for STEMI, contrast-enhanced magnetic resonance imaging was performed. Infarct size and transmurality on delayed-enhancement imaging were measured. Infarct size was not associated with symptom onset-to-balloon time (23 +/- 9% for <180 minutes, 22 +/- 9% for 180 to 360 minutes, and 24 +/- 11% for >360 minutes, p = 0.62) or door-to-balloon time (23 +/- 8% for <90 minutes, 23 +/- 10% for 90 to 120 minutes, and 22 +/- 11% for >120 minutes, p = 0.88). Infarct transmurality increased significantly with a delay of symptom onset-to-balloon time (73 +/- 22% for <180 minutes, 78 +/- 14% for 180 to 360 minutes, and 86 +/- 14% for >360 minutes, p = 0.04), but not for door-to-balloon time (79 +/- 15% for <90 minutes, 76 +/- 19% for 90 to 120 minutes, and 81 +/- 18% for >120 minutes, p = 0.62). In multivariate analysis, anterior infarction (odds ratio 4.15, 95% confidence interval 1.31 to 13.18, p = 0.02) and myocardial blush grade 0/1 (odds ratio [OR] 3.89, 95% confidence interval [CI] 1.13 to 13.51, p = 0.03) independently predicted a large infarct (infarct size > or =25%). Symptom onset-to-balloon time (OR per 30 minutes 1.26, 95% CI 1.04 to 1.53, p = 0.02) was an independent predictor of transmural infarct (average transmural extent > or =75%) and use of glycoprotein IIb/IIIa inhibitors showed a protective effect (OR 0.09, 95% CI 0.02 to 0.53, p = 0.007). In conclusion, symptom onset-to-balloon time was significantly associated with infarct transmurality but not infarct size in patients undergoing primary PCI for STEMI.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
authors.forename: Yeon Hyeon
authors.initials: YH
authors.lastname: Choe
authors.forename: Jun Hyung
authors.initials: JH
authors.lastname: Kim
authors.forename: Jidong
authors.initials: J
authors.lastname: Sung
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Choi
authors.forename: Duk Kyung
authors.initials: DK
authors.lastname: Kim
authors.forename: Kyung Pyo
authors.initials: KP
authors.lastname: Hong
authors.forename: Jeong Euy
authors.initials: JE
authors.lastname: Park
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology* / Q000628:therapy*; D013997:Time Factors